Provider Demographics
NPI:1265660260
Name:DAILEY, JONATHAN JAMES (LAC)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:JAMES
Last Name:DAILEY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 N MAKALEHA PL
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-9454
Mailing Address - Country:US
Mailing Address - Phone:808-344-8653
Mailing Address - Fax:
Practice Address - Street 1:229 N MAKALEHA PL
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-9454
Practice Address - Country:US
Practice Address - Phone:808-344-8653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU-942171100000X
ORAC01215171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist